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-FOR OFFICE USE: <br /> f. APPLICATION FOR SANITATION PERMIT <br /> -- --------- ------------ ----- (Complete in Triplicate} Permit No. <br /> - <br /> -------- ------- - - - - --------------------- <br /> Date issued <br /> 1----------------------------------- --------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .-za f f-r--�1---[ ,(�I L�Q � '------�I' .4�+-..----CENSUS TRACT ----------------_ ...... <br /> Owner's Name ----44&-' e,11-----WA&W— I- --------------------- ------------------------ -------------------Phone --------------------------------- <br /> Address ----------� g?YV--4�n---------- ---------------------------------------- -------- --� . city <br /> -.. , -------------------------------- <br /> - <br /> Contractor's Name ------�oprp '`f+-_"_A_�-----------------------------------License <br /> Installation will serve: Residence XApartment House,❑ Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other <br /> Number of living units:---_- -__ Number of bedrooms _". .....--Garbage Grinder 4149 Lot Size _(Q+ -C_;;;k------------------- <br /> Water Supply: Public System and name ----------------------•---------------------------------------------------------------------------------------Private) <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ PeatoW Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material --------- -- If yes, type -------------------____---_ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size - �____r`_V_'04'---�Yf1- -_ Liquid Depth -� ---------- ---� <br /> Capacity - ?00---- Type Material(a �No. Compartments -- ------------- <br /> C6 <br /> Distance to nearest: Well �f?49--�-------------------Foundation�_��------------- Prop. Line - ._Q__`--.--_-- Cr_ <br /> LEACHING LINE [ j No. of Lines - C�----------- ---- Length of each line-_X_Z_7a-----------__ Total Length -- �^-�,C___---.. <br /> D' Box <br /> - Type Filter Material 1?�De th Filter Material - <br /> YP P <br /> Distance to nearest: Well * - Foundation _3Y-------------- Property Line ----- <br /> SEEPAGE PIT [ ] Depth - Diameter - Number ---------------- ----------- Rock Filled Yes ❑ No i❑?, <br /> WaterTable Depth ------------------------------------------......Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------___.__--..__..� <br /> REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------__.__-._----__-_--_-__-_-_--) <br /> Septic Tank (Specify Requirements) --- ----------------- ------------------------------------------------------.----------------------- - <br /> Disposal Field (Specify Requirements) ----------- ----------------------------------------------------- - ---- <br /> --------- l -------------------------------- - ---------- ----------------------------------------------------------------------------------- ------------------------ <br /> (Draw existing a"nd required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------- -- ----- ------------------- Owner <br /> 8Y ' Title - ------------------------------- <br /> 10- ---— <br /> (If other than owner) <br /> FOR DEP U ONL <br /> APPLICATION ACCEPTED BY ---- DATE �fl ------------ <br /> - - --- --- <br /> BUILDING PERMIT ISSUED --------------------------------- --- ----------------------------------------.DATE ---------- ------------------------ <br /> ------ ---------- ---- <br /> ADDITIONAL COMMENTS ------------------------------------------------------------------------------ ----------------------------------------------- - <br /> ---f-- <br /> --------- ----------- <br /> -------------­­--------------------------------------- <br /> ----------------------- -- --------------------------------------- -------------- ------------------- ------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------- ----------- ----- - ---- - ------------ - -------------------------------------------------------------- - <br /> ----------- <br /> ---------------------------- -------------------- -- --- --- - -------------------------------------------------------------- <br /> Final Inspection by: <br /> - ------ Date <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />